My MCAP -
What You Need to Know After You Are Enrolled |
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In order for MCAP to continue to provide services, you must help us in the following ways:
Changing Your Address
You must write to MCAP to inform them of any changes with your home phone or billing address or if you move out of state. This letter must be sent 30 days before you move.
Mail or FAX your letter to:
Medi-Cal Access Program
P.O. Box 15559
Sacramento, CA 95852-0559
FAX: (888) 889-9238
If You Get Other Insurance
If you get other insurance after you are enrolled in MCAP, you must write to the MCAP (at the address shown above) right away. This is very important because MCAP only pays for benefits not covered by your other insurance.
Transferring to Another Health Plan within MCAP
All transfer requests must be approved by MCAP.
Mail or FAX your letter to:
Medi-Cal Access Program
P.O. Box 15559
Sacramento, CA 95852-0559
FAX: (888) 889-9238
How long can you be enrolled in MCAP?
When will your coverage end?
If you are enrolled, the MCAP will provide comprehensive health care during your pregnancy and through the last day of the month in which the 365th day following the end of the pregnancy occurs. MCAP is only for one pregnancy at a time and cannot cover services received after the last day of the month in which the 365th day from when your pregnancy ended. You must notify MCAP within 30 days after the end of your pregnancy.
What you need to do once your baby is born?
MCAP will mail you an Infant Registration Form 30 days before your estimated date of delivery and you need to return the completed form. You may also use the
Infant Registration Form. If you have your baby early or you do not want to register your baby for public coverage, you still must notify the MCAP within 30 days from when your pregnancy ends. MCAP cannot cover any medical services you receive after the last day of the month in which the 365th day from when your pregnancy ended.
What if you have a difficult pregnancy?
MCAP provides comprehensive health care for your pregnancy in an effort to help you. MCAP understands that sometimes women have difficult pregnancies, and is sorry for any difficulties you may experience. If you are still pregnant after your start date of coverage, MCAP will provide comprehensive health care during your pregnancy and through the last day of the month in which the 365th day following the end of the pregnancy occurs.
MCAP cannot cover any medical services you receive after the last day of the month in which the 365th day following the end of your pregnancy occurs. You need to notify MCAP within 30 days after the end of your pregnancy.
For services you got before your MCAP coverage start date
MCAP will pay back up to $125 for pregnancy-related, medically necessary services that you got no more than 40 calendar days from the date the MCAP received your completed application.
MCAP must receive your request to be paid back, including proof of payment for services, no more than 90 calendar days from the date the services were performed.
You must give MCAP:
- A photocopy of the bill with the medical provider's name and business address.
- Your name, address, date of birth and Social Security number (optional) on the request.
- The dates, amount paid, and type of medical service you received.
Mail or fax your request to:
Medi-Cal Access Program
P.O. Box 15559
Sacramento, CA 95852-0559
Fax: (888)-889-9238What if you are no longer pregnant after your start date of coverage?
You are still eligible for 365 days of postpartum coverage if you have an early end of your pregnancy. Please inform MCAP within 30 days that your pregnancy has ended to ensure your postpartum coverage begins. MCAP cannot cover any medical services you receive after the last day of the month in which the 365th day following the end of your pregnancy occurs. You may use the Early End of Pregnancy Form to inform MCAP that your pregnancy has ended.
Notifying MCAP when your pregnancy has ended
Within 30 days, you must notify MCAP of the date that your pregnancy ended by submitting the
Infant Registration Form.
Mail or fax your letter to:
Medi-Cal Access Program
P.O. Box 15559
Sacramento, CA 95852-0559
Fax: 1-888-889-9238
If you would like to request a form or have questions regarding your MCAP coverage, please call MCAP Monday through Friday, 8:00 a.m. to 8:00 p.m., or on Saturday, 8:00 a.m. to 5:00 p.m. at 1-800-433-2611.
How You May Be Disenrolled
You will be disenrolled if:
- You write to MCAP and ask that your coverage be cancelled.
- You no longer live in California. You must write to MCAP within 30 days to notify them of this move.
- You commit fraud against MCAP. This includes giving false information on your application.
- You will be disenrolled the last day of the month in which the 365th day following the end of the pregnancy occurs. You must notify MCAP within 30 days after your pregnancy ends.
MCAP will inform you of the disenrollment and the reason. If you are disenrolled for reasons 1-3 above, your MCAP coverage will end at the end of the calendar month in which the request was received or at the end of a future calendar month as requested. Once you are disenrolled from MCAP, you cannot reenroll for the same pregnancy.
Eligibility Appeals
If you disagree with a decision that MCAP has made regarding your eligibility, disenrollment, or transfer, you may appeal to MCAP. Your appeal must be in writing and submitted to the address provided below within 60 calendar days from the date of the decision letter. An appeal shall include all of the following:
- A statement specifically describing the issues which are disputed.
- A statement of the resolution requested.
- Any other relevant information. This includes copies of the decision letter and all the documentation submitted with the MCAP application (except for the payment).
Mail your appeal to:
Medi-Cal Access Program
P.O. Box 15559
Sacramento, CA 95852-0559
The Department of Health Care Services (DHCS) Benefits Appeal Process
You should first attempt to resolve disputes with the plan according to its established policies and procedures. If you are dissatisfied with the resolution of your grievance you can appeal to the California Department of Health Care Services (DHCS).
The benefit appeal must be submitted to DHCS in writing within sixty (60) calendar days following the Plan's decision. The appeal must include the following:
- A copy of any decision being appealed or a written statement of the action or failure to act being appealed;
- A statement specifically describing the issue you are disputing;
- A statement of the resolution you are requesting; and
- Any other relevant information you would like to include.
Appeals that do not include the above information will be returned. You may resubmit the complete appeal within sixty (60) calendar days from the plan's denial or within twenty (20) calendar days of the receipt of the returned appeal, whichever is later.
Mail or FAX your appeal to:
Department of Health Care Services
Medi-Cal Eligibility Division
Medi-Cal Access Program Unit
1501 Capitol Avenue MS 4607
P.O. Box 997417
Sacramento, CA 95899-7417
(916) 552-9200-Public
Fax: (916) 552-9478
